Thursday, November 15, 2012

He could have been anyone’s little brother: A football-loving 9-year-old with a brave grin and a fatal case of leukemia. As his story percolated through the local news and radio station, it touched no one more than the football team at Eagle Valley High School. Players signed a football for Alex. They pasted A’s to their helmets. They donned orange knee socks to commemorate the cancer ravaging his body. A Facebook page in his honor collected hundreds of supporters.

And when word spread late last month that Alex had died, the grief was real.

Trouble was, Alex was not.

The New York Times has a good old fashioned hoax story today, with a twist: this one was not used to make money. In fact, they know who did it — Briana! — but not why, and no crime was committed, so she can just ride off into the sunset with this terribly awkward cocktail party story in her back pocket.

@frigwiggin The actual reward of Munchausens by proxy lies in receiving medical attention for the child, not community sympathy. This is more likely innocuous antisocial behavior, manipulating people's feelings for the joy of being able to do it.

@frigwiggin @bloodrocuted Munchausen by Internet is...sort of a thing. It certainly seems like a manifestation of a factitious disorder to me, less dramatic than Munchausen by proxy (no child abuse! that's a plus) or classic Munchausen's, but I don't know that that's much more than a product of how psychological conditions get expressed in ways that are shaped by cultural context. Before the Internet, it was difficult to deceive people for prolonged periods and nearly impossible to get major outpourings of sympathy from large numbers of strangers, and now it's easy.

@Lorelei@twitter I don't buy that they're on the same scope. If the goal of Munchausens by proxy was to get community attention, they would match. However, the most common goal is be in the hospital. As for me, I haven't studied any Munchausens by proxy cases that included the community (such as a prayer circle) which would be more analogous to internet attention.

Another reason I believe the two are unrelated is that episodes of Munchausens are caused by stress. It is hypothesized that the stress leads people to seek a place they associate with healing.

Antisocial behaviors are caused by boredom. The story does not mention any stressors in the woman's life. Your article mentions: "people who... divulge eventually that they created it all to fool a doctor". People whose goal is manipulation, not a subconscious desire to be healed, would fall under people with antisocial tendencies.

@Bloodrocuted I'm not trying to say they are the *same* disorder, any more than Munchausen and Munchausen by proxy are the same. But they are two paths to the same basic motivator: the kind of care and support provided to the sick that sufferers don't know how to seek in healthy ways. I'm certainly not an expert on Munchausen, but when I studied abnormal psychology, my understanding was that it's just a particularly intense variety of physical factitious disorder, which you can definitely have without going as far as extreme Munchausen's cases can go. I don't at all see a clear and obvious distinction between "a conscious goal of manipulation" and "a subconscious desire to be healed," (I don't really think even the motivations of well people can be so neatly divided, in most cases. People are complicated) and my general perspective on mental illnesses is that they are complex, varied, and we are far from a complete understanding of any of them.

In any case, community support can indeed play a big role in Munchausen by proxy, when the sufferer is not seeking direct medical attention but praise for being a loving and selfless caregiver to the child.

[http://behavenet.com/factitious-disorder|The basic diagnostic criteria] for factitious disorder are "A. Intentional production or feigning of physical or psychological signs or symptoms.

B. The motivation for the behavior is to assume the sick role.

C. External incentives for the behavior (such as economic gain, avoiding legal responsibility, or improving physical well-being, as in Malingering) are absent.

And a lot of the internet-based illness faking follows that pattern exactly. People are seeking a sense of importance and being cared through the role of illness.

@Lorelei@twitter Actually, it's not difficult to identify people's mental conditions. It's not what a person do that defines the illness, it's the goal a person hopes to achieve. In other words, a person's desires identify a person's disorder.

For example: a patient with paranoid PD and a patient with schizoid PD both avoid socialization. The former avoids out of fear and the latter avoids out of apathy. As for diagnosis, treatment, and prognosis, the "why" is important.

People with antisocial PD naturally have a lowered arousal rate. They also literally lack the ability to empathize or feel remorse. They will manipulate people for pleasure, because breaking social norms is accessible and extreme enough to make them excited. Someone with Munchausens is not harming themselves or another person on purpose. They genuinely feel they must get medical treatment. These two cases could end the same, but someone with antisocial PD would do this maliciously and someone with Munchausens would do this with positive intentions.